DI 52715.020 Disability Determination Services (DDS) Adjudication
The prior file must be obtained anytime that the Albright Acquiescence Ruling (AR) applies in adjudicating a subsequent claim. If the prior file is not available, a copy of the administrative law judge (ALJ) or Appeals Council (AC) decision should be secured. See DI 52715.020B.1. Normal case development procedures apply.
1. Prior file activities
a. Regular procedures
It is the field office (FO) jurisdiction to obtain prior files on newly filed claims with potential Albright issues. For Albright issues discovered during case development, see DI 20505.001.
The prior folder containing the ALJ or AC decision (or else a copy of that decision) must be obtained to process a subsequent claim under the Albright AR. If the folder cannot be located, then a copy of the ALJ or AC decision needs to be obtained. If the prior ALJ or AC decision is not available from within SSA or from the claimant, then the Albright AR cannot be applied.
b. Special instructions for Albright AR
Do not process the subsequent claim under the Albright AR if any one of the requirements in DI 52715.005 is not met.
In situations where the requirements listed in DI 52715.005 are met and there is no information in the current file regarding the prior file, ask the FO to obtain a copy of the ALJ or AC decision from the claimant or ODAR and to initiate actions described in DI 20505.015 for obtaining the prior file.
If only the prior ALJ or AC decision is available, apply the Albright AR using the decision.
If the prior folder is lost or has been destroyed and the prior decision cannot be obtained, document the file to show this and take no further action with regard to the AR (see DI 52715.010A.3.).
NOTE: If the AC takes an unfavorable action on a claimant's request for review, the claim file is retained in ODAR Headquarters for 5 months pending potential filing of a civil action. In such instances the FO will obtain a copy of the ALJ or AC decision. Apply the AR using a copy of the ALJ or AC decision. The ALJ or AC decision generally contains a detailed discussion of the evidence and the findings of fact.
2. Medical/Vocational development and evaluation for Albright AR
Undertake normal development of the current claim.
Review the findings of the claimant's residual functional capacity (RFC), education, and work experience, or other finding described in DI 52715.010B.1.a. or DI 52715.010B.1.b., as appropriate, from the final ALJ or AC decision.
Weighing the Prior Findings
Consider if the evidence is likely to change with time.
Consider the time interval between the previously adjudicated period and the period being adjudicated in the subsequent claim.
Consider the extent to which evidence not considered in the prior final decision provides a basis for a different finding for the period under adjudication in the subsequent claim.
Consider if there has been a change in the law, regulations or rulings affecting the finding or the method for arriving at the prior finding. If so, do not consider the prior finding in the subsequent decision.
NOTE: An examiner (Single Decision Maker pilot or prototype) or DDS medical or psychological consultant must sign an RFC assessment. The examiner or DDS medical or psychological consultant should record the analysis and weight of the prior findings on the RFC or MRFC forms.
If there are two or more prior claims with final ALJ or AC decisions, adjudicate the current claim under the Albright AR in accordance with the instructions below. (See DI 52715.010B.4. and DI 52715.010B.5. for definitions of interim period cases and post-publication cases. See DI 52715.010B.1.a. and DI 52715.010B.1.b. for a list of the sequential evaluation findings to which the Albright AR applies.)
IF the most recent ALJ or AC decision was issued before 4/22/99 (that predates Albright),
THEN Consider sequential evaluation findings only from the most recent ALJ or AC decision.
IF the most recent ALJ or AC decision was issued on or after 1/12/00 (effective date of the Albright AR) and any other previous ALJ or AC decisions were before 4/22/99,
THEN consider sequential evaluation findings only from the most recent ALJ or AC decision.
IF the most recent ALJ or AC decision was issued during the period from 4/22/99-1/11/00 (interim period case) and there is another, pre-Albright ALJ or AC decision (i.e. issued before 4/22/99),
THEN consider sequential evaluation findings from both decisions.
IF the most recent ALJ or AC decision was issued during the period from 4/22/99-1/11/00 (interim period case) and there are two or more pre-Albright ALJ or AC decisions,
THEN consider sequential evaluation findings from the interim period case and the most recent pre-Albright decision.
If concurrent title II/title XVI claims are filed subsequent to a final decision which was made by an ALJ or the AC in connection with a single claim of the individual under one title, first adjudicate the new claim that is under the same or a different title of the Act as the claim decided in the ALJ or AC decision in conformity with the AR. If the AR applies, consider as evidence any of the findings described in DI 52715.010B.1. from the ALJ or AC decision in determining disability on the new claim under the same title as the prior claim and give any such finding appropriate weight in light of all relevant facts and circumstances. The determination on the issue of disability on this new claim then may be adopted for the same period for the concurrent claim under the other title, provided that the same rules for determining disability apply (see DI 27515.001).
3. Readjudication of an interim period case
The claim in an interim period case will be readjudicated under the Albright AR if:
The individual requests application of the AR and demonstrates that application of the ruling could change the final determination or decision on the claim (see DI 52715.010C.1.a.); OR
The interim period case is discovered in the course of development/adjudication of a current claim of the individual and the adjudicator concludes that application of the AR would change the final determination or decision on the prior claim (see DI 52715.010C.1.b.).
The readjudication of a claim under the Albright AR in an interim period case is distinct from the rules for reopening and revising final determinations or decisions. A claim on which there was a final determination or decision in the interim period described in DI 52715.010C.1. may be readjudicated under the AR even though the 4-year rule (title II) or 2-year rule (title XVI) for reopening does not apply.
4. Evaluation of findings in the prior ALJ or AC decision
Facts upon which prior ALJ or AC findings are based can be static or non-static.
Static facts are those that are not expected to change with the passage of time, such as the physical or mental demands of a claimant's previous job or the skill level of a previous job.
Non-static facts are those that are subject to change with the passage of time (e.g., a fact relating to the severity of the claimant's medical condition). A finding about a non-static fact would include a finding that a claimant does or does not have an impairment that is severe.
Treat the sequential evaluation findings from the prior ALJ or AC decision as evidence to be weighed with the evidence in the subsequent claim.
Consider whether the fact on which the prior finding was based is non-static and subject to change with the passage of time (e.g., the severity of the claimant's medical condition or the findings of a claimant's RFC).
Consider the likelihood of a change in the non-static fact considering the time that has elapsed between the previously adjudicated period and the period adjudicated in the subsequent claim.
Consider the extent to which evidence not considered in the final decision of the ALJ or AC in the prior claim provides a basis for making a different finding for the period now being adjudicated.
Consider the type and severity of the impairments. A chronic or progressively severe impairment may be more likely to support a reduced RFC in a subsequent claim. An impairment that could be expected to improve would be more likely to support an increased RFC.
In general, give more weight to prior findings on non-static facts from decisions made when the previously adjudicated period is closer in time to the period currently under adjudication.
Conversely, give less weight to prior findings made distant in time to the period currently under adjudication since there would be greater likelihood that the facts have changed and therefore that a different finding could be made for the period currently being adjudicated.
In general, give static facts the controlling weight in a subsequent claim unless evidence not considered in the prior decision provides a basis for making a different finding.
Consider any evidence not available at the time of the prior final decision by the ALJ or AC. New evidence could result in a different finding with respect to the period being adjudicated in the subsequent claim.
Evaluate each claim according to its own facts and circumstances.
Generally, findings for unfavorable and partially favorable ALJ or AC decisions are summarized near the end of the decision under a section labeled "Findings" or "Findings of Fact." However, regardless of the format of the ALJ or AC decision, a finding, as described above, must be considered as evidence and given appropriate weight as set forth in the Albright AR.
5. Preparing the determination
When applying the AR, explain in the PDN or in the rationale the basis for the findings on the current claim. This explanation can be included by the adjudicator on the RFC/MRFC, if appropriate, or on a Report of Contact (SSA-5002) form placed in the file.
When you are making a finding under the Albright AR, the rationale statement must include an explanation of how the prior findings were weighed. Discuss the type of fact (static or non-static) on which the prior finding was based; for a finding on a non-static fact the time interval between the previously adjudicated period and the period currently being adjudicated and the likelihood of change in the non-static fact due to the time interval; and the extent that evidence not considered in the prior decision provides a basis for making a different finding with respect to the period currently being adjudicated.
The rationale should reflect the appropriate consideration and weight given a prior finding pursuant to the Albright AR, whether the decision by the DDS makes a different or the same finding as the finding by the ALJ or AC.